Post written by Ryan Law, DO, from the Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
We present a 56-year-old woman with history of lupus and laparoscopic Roux-en-Y gastric bypass (RYGB), complicated by a persistent anastomotic ulcer ultimately requiring partial gastrectomy and esophagojejunostomy who was referred for endoscopic management of an esophagojejunal (EJ) anastomotic stricture. Following multiple unsuccessful sessions of endoscopic balloon dilation, we elected to place a lumen-apposing stent (LAMS) across the anastomotic stricture for further treatment. Following placement of a 15-mm x 10-mm LAMS, the patient developed resolution of dysphagia. Repeat upper endoscopy 4 weeks later was performed, and the stent was removed. The anastomosis was widely patent. Five months following LAMS removal, the patient tolerated a near normal diet and her weight increased by 15 pounds. Of note, this is an off label use of a LAMS as it is not FDA-approved for this indication.
We believe that LAMSs may provide an effective management strategy for refractory short anastomotic strictures following failed serial endoscopic dilations.
This case demonstrates successful use of a LAMS for treatment of an anastomotic stricture after esophagojejunostomy. While this technique requires further evaluation, it should be considered as a viable option to more invasive interventions when conventional options are unsuccessful.
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